Dr. Paul Keckley Paul H. Keckley, Ph.D. Deloitte Center for Health Solutions Washington, DC KEYNOTE: Health Reform – What does it mean for SE Michigan? What can we do?
Jan 26, 2016
Dr. Paul KeckleyPaul H. Keckley, Ph.D.Deloitte Center for Health SolutionsWashington, DC
KEYNOTE:
Health Reform – What does it mean for SE Michigan? What can we do?
The US health system: big, complex, fragmented, uneven…
Deloitte Center for Health Solutions 2008
BIOTECH
INNOVATORS
ADMINISTRATORS/WATCHDOGS
SERVICE PROVIDERS
Physicians
HCIT
Pharma
Device
HospitalsOutpatientFacilities
Insurers
Regulators
Long TermCare
BioTech
Professional Societies/
Special Interests
Accrediting Agencies
DiseaseManagement
Employers
CAM
Media
AcademicMedicine
CONSUMERS
Allied HealthProfessionals
Costs, access and quality are major issues!
Deloitte Center for Health Solutions 2008
Lack of capital and resources
Explosion in clinical
knowledge
Lack of political will, leadership
Lack of consumer
involvement
Lack of appropriate technology
Lack of trust among Key
Players
Lack of incentives for
right behaviors
Runaway Costs
Uneven Access
PoorQuality
The majority support reform: Two in five rate the system unfavorably
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How Would You Grade the Overall Performance of the U.S. Health Care System?
2%
18%
43%
25%
13%
A(Excellent)
B C(Average)
D F(Failing)
38%
Deloitte's 2009 Survey of Health Care Consumers
20%
Unfavorable report card grades are more likely
among Gen X and Boomers (4 in 10) than among Gen Y and Seniors
(3 in 10)
Unfavorable report card grades are more likely
among Gen X and Boomers (4 in 10) than among Gen Y and Seniors
(3 in 10)
Most do not understand the “system” and believe it is wasteful. Insecurity about health costs is high:Seniors “in public plan” most favorable.
Total1982 - 1993
(Gen Y)1965 - 1981
(Gen X)1946 - 1964 (Boomers)
1945 and earlier
(Seniors)
Overall performance of the U.S. health care system (% grade D/F) 37.3% 30.9% 40.6% 41.4% 28.9%
Comprehension of how the U.S. health care system works (% who say they understand somewhat)
25.3% 33.1% 27.3% 23.7% 18.4%
% who believe more than 50 percent of the U.S. health care system expenditures are wasted
50.5% 49.8% 57.0% 51.4% 37.3%
Extent household is financially prepared to handle future health care costs (% who feel somewhat secure)
33.6% 26.7% 40.0% 38.8% 17.4%
Source: 2009 Deloitte Survey of US Health Consumers, Deloitte Center for Health Solutions
Public opinion about health reform (Deloitte Pulse Survey, September 10-13, 2009)
54% of U.S. adults believe health care reform will not pass this year vs. 41% who do 48% believe the U.S. health system needs a major overhaul—among the uninsured
(60%) and underinsured (55%) 73% of respondents believe it is important for every American to have health
insurance but 55% do not believe coverage for the uninsured should be the sole focus of the debate
The most trusted sources to reform health care are providers (37%), the White House (21%), Congress (13%), employers (11%) and health insurance companies (7%)
61% believe that Congress is likely to make the health care situation worse than better
55% believe government solutions to health care will cost more and deliver less compared to private sector solutions.
51% believe health reform should not wait until the economy is better compared to 47% who thought it should wait.
White House #1 domestic issue: Reduce costs, cover everyone
• February 24, 2009 to joint session of Congress: Reform energy, education and health care. Pass bill in 2009.
• May 11, 2009 to major trade organizations: Cut CAGR to 4.7%, reduce costs by $2 trillion (2008 – 2018).
• June 3, 2009: Everything on the table—mandates, employer tax exclusion, employer mandate, public plan, etc.
• September 9, 2009: President Obama’s address to joint session of Congress, reiterating commitment.8
White House messaging:•Reform is necessary to create competition in the insurance market
•Reform is necessary to economic recovery
•Reform is a moral imperative
•Reform must be deficit neutral
Major elements of the “Kennedy” reform bill--
•Access--Individual mandate, Medicaid expansion, employer mandate
•Quality—comparative effectiveness, episode-based payments, transparency
•Cost—insurance regulation, health exchanges
Looking ahead…a bill in December 2009 (~$900 billion)
ConsumerismFocus:
Self careAchieves $ TBD
Comparative Effectiveness/EBMFocus: (1) Personalized medicine,
(2) bundled based payments, (3) provider adherence/performance-based payments
Achieves uo to $30B/yr savings
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Health Care Information TechnologyFocus: (1) e-prescribing, (2) fraud detection
(3) administrative cost reduction , (4) care coordinationAchieves $33-70 B/ yr savings
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3
4
Primary Care 2.0
Focus: Prevention, Chronic, LTC
Achieves $24-57B/yr savings
Major Sources of funding
• Medicare cuts
• Industry fees
• Cadillac plans
• Income taxes
As of October 15—40 proposals, 3 major bills
Senate Finance Senate HELP House Tri Committee
2019 Coverage, Cost
94%$829B
93%$1.2T
97%$1.182T
Individual mandate
YesPenalty: $750/1500 Subsidy:to 400% FPL
YesPenalty:Subsidy to 400% FPL
YesPenalty: 2.5% AGI Subsidy: to 400% FPL
Employer mandate
YesSize: 50+ employeesPenalty: $400/employee if tax credits used
Yes (Must pay 60% of premiums or $750/employee)
YesSize: 25+ employees Penalty: 2-8% of payroll
Medicaid expansion
Yes (133% FPL) Yes (150% FPL) Yes (133% FPL)
Insurance reforms
Yes Yes Yes
Comparative effectiveness
Yes No No
Liability reform No No No
Performance-based payments
Yes Yes Yes
In southeast Michigan, what if…
Every price for every healthcare transaction was known before the purchase?
Every treatment recommendation was based on evidence ?
Every dollar spent for facilities and technology necessary?
Every person knew as much about the industry as they know the auto industry?
Every person lived a healthier life and managed their own care?
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